Garry Shandling and the Disease You Didn’t Know About

Unlike most people writing reflections on the late Garry Shandling, I had no personal or professional connection to him. Of course I thought he was funny, in a pioneering cringe-inducing way. And like many people I am of course sorry that he has died.

But here is why I am stepping outside my normal realm of discourse to say something more in the wake of his death. In his wonderful and touching “Comedians in Cars Getting Coffee” segment with Jerry Seinfeld, filmed not long before his death, Shandling mentions that he’s been diagnosed with an obscure disorder called hyperparathyroidism. He makes it a joke: “The symptoms are so much like being an older Jewish man, no one noticed!” But I noticed this mention, and I think it’s worth broader attention.

* * *

The parathyroid (PT) glands, as I have come to know, have nothing to do with the much more famous thyroid gland. Most people have four of them, usually located in the neck; they are very small, and they regulate the level of calcium in the blood. For most healthy people, the blood-calcium level is confined within a narrow range. If your reading goes above that range, it likely means that something has gone wrong with one of your PT glands, usually because of a noncancerous tumor called an adenoma. If that is so, it likely means that you won’t get better until the gland is surgically removed. As long as it is there, it will keep pumping out hormones that direct your body to keep raising the blood-calcium level, even though that is already too high. Usually just one of the glands has developed a disorder, and usually people can get along fine after having one, two, or even three of the four PT glands removed. But until the bad one is taken out, your health is going to get worse and worse and worse. One of the ways it might deteriorate is through a premature tendency to heart attacks—and a heart attack appears to have been what felled Garry Shandling at age 66.

I know all this because the only real health problem I’ve ever had was a parathyroid disorder, starting ten years ago. When I was just about to move to China in 2006, my American doctor said that a blood-calcium level looked high, and we should keep an eye on it. When I was back for a visit a year later, he said it was a little higher. After that, at his advice, I went to a clinic in Beijing every few weeks for a blood reading. (When they draw blood in Chinese clinics, at least the ones I went to, they don’t use the rubber strap that makes your veins pop out and thus easier to find and pierce. I never could figure out the explanation, but I can tell you that having the technician prowl around in your arm with the needle, in search of a vein, adds a whole new attention-getting aspect to having your blood drawn.)

Test by test, the calcium reading kept going up. I had a grueling “24-hour total calcium excretion” test (don’t ask) on a visit to DC early in 2008, which confirmed that I had a PT problem. My wife and I traveled all through the hinterland of China in much of 2008, before returning to Beijing for the Olympics. The blood readings kept getting worse. Finally in early 2009 we came back from Beijing to San Francisco on a medical trip. At the UCSF hospital, a main west coast center for this kind of procedure, I had a five-hour operation, conducted by Quan Duh and his team. They removed what turned out to be a single aberrant PT gland, which turned out to have migrated from my neck to somewhere in my chest. That immediately resolved the problem, and I have felt fine ever since.

* * *

As the son of a doctor, I hate the idea of being sick, and hate even more talking about it. I disclose the medical details in this case, occasioned by the Shandling news, because I know something that most people don’t, and that might help some others. Which is: If you think you have this problem, get it addressed right away. Don’t wait, as I did.

I’d postponed getting the surgery as long as possible, for a variety of reasons. I avoid surgery in general, and apart from a childhood tonsillectomy had never been operated on. I was in the middle of an engrossing China assignment and didn’t want to break it up. I knew that the cutting-and-probing of PT surgery takes place around the larynx, the vocal cords, and all related nerves, and thus carried a minor but real risk of permanent voice damage. And—the main point—since I’d never heard of this disease (and had barely heard of the parathyroids), I didn’t take the situation seriously.

When I met Dr. Duh in San Francisco to discuss whether I actually needed the operation, he told me that in overall toll on well-being, a parathyroid disorder was about as damaging as smoking a pack of cigarettes per day. It weakened the bones; it raised the risk of heart attacks and some cancers, and kidney stones too; it caused mood disorders; and—I’ll confess the most alarming—it led to memory lapses, attention failures, and dementia. The bone-weakening is because the hyperactive gland continually draws calcium out of the bones and into the blood serum. Most of the other problems are because of disturbances in calcium’s role as a neurotransmitter. My wife later told me that she thought I was getting dumber by the day in the year before the operation. In my defense, I was turning out a longstream of articles and web posts through that time (the year of the Beijing Olympics, and of the Obama-McCain election), plus radio broadcasts. Think how good they might have been!

Parathyroid disease (hyperparathyroidism) causes symptoms in most people, but it will decrease the life expectancy in all patients by about 5-6 years if the parathyroid tumor is not removed … Most people with hyperparathyroidism don't feel well. Parathyroid tumors take away the “joy of life.”

If I had known ten years ago what I know now, I would have had the surgery as soon as the diagnosis was confirmed. The problem was not going to cure itself, and it made me a little sicker and weaker every day that I delayed. With any luck, this will be the only medical history you will ever hear from me in this space. And seriously, get treatment soon if you have this problem. I wish I had.

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James Fallows is a staff writer at The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Jimmy Carter's chief speechwriter. He and his wife, Deborah Fallows, are the authors of the 2018 book Our Towns: A 100,000-Mile Journey Into the Heart of America, which was a national best seller and is the basis of a forthcoming HBO documentary.